Ultrasound-guided forearm nerve blocks are an effective method to provide analgesia for hand injuries. Because most hand injuries don’t require orthopedic consultation, we recommend that clinicians new to ultrasound-guided regional anesthesia start with ultrasound-guided forearm nerve blocks. In an era of opioid-sparing pain management, these techniques are an ideal addition to the broad armamentarium of the emergency physician.
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ACEP Now: Vol 35 – No 10 – October 2016Dr. Wroe is a senior resident at Highland Hospital, Alameda Health System, in Oakland, California.
Dr. Nagdev is director of emergency ultrasound at Highland Hospital, Alameda Health System, in Oakland, California, and assistant clinical professor at the University of California, San Francisco School of Medicine.
References
- Andrade A, Hern HG. Traumatic hand injuries: the emergency clinician’s evidence-based approach. Emerg Med Pract. 2011;13(6):1-23.
- Angermann P, Lohmann M. Injuries to the hand and wrist. A study of 50,272 injuries. J Hand Surg Br. 1993;18(5):642-644.
- de Putter CE, van Beeck EF, Polinder S, et al. Healthcare costs and productivity costs of hand and wrist injuries by external cause: a population-based study in working-age adults in the period 2008-2012. Injury. 2006;47(7):1478-1482.
- Liebmann O, Price D, Mills C, et al. Feasibility of forearm ultrasonography-guided nerve blocks of the radial, ulnar, and median nerves for hand procedures in the emergency department. Ann Emerg Med. 2006;48(5):558-562.
- Frenkel O, Liebmann O, Fischer JW. Ultrasound-guided forearm nerve blocks in kids: a novel method for pain control in the treatment of hand-injured pediatric patients in the emergency department. Pediatr Emerg Care. 2015;31(4):255-259.
- Sohoni A, Nagdev A, Takhar S, et al. Forearm ultrasound-guided nerve blocks vs landmark-based wrist blocks for hand anesthesia in healthy volunteers. Am J Emerg Med. 2016;34(4):730-734.
- Wroe P, O’Shea R, Johnson B, et al. Ultrasound-guided forearm nerve blocks for hand blast injuries: case series and multidisciplinary protocol. Am J Emerg Med. 2016;34(9):1895-1897.
- Toles K, Nagdev A. Trick of the trade: patient positioning for ultrasound-guided ulnar nerve block. Academic Life in Emergency Medicine website. Accessed Sept. 14, 2016.
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